Transcript Write here… - Walsingham

My hospital passport
My name is
Replace with photo of
person if possible; if
not delete this box
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I like to be called
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If I have to go to hospital this book needs to go with me.
It gives hospital staff important information about me.
It needs to be at the end of my bed. A copy should also
be put in my notes.
This passport belongs to me.
Please return it when I am discharged.
Nursing and medical staff please look at my passport
before you do anything involving me.
Things you must know about me
Things that are important to me
My likes and dislikes
Things you must know about me
Date of birth
Address
Telephone
This is how I tell
people how I feel
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Family contact
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Relationship
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Address
Telephone
My support needs
and who gives me
the most support
My carer speaks
Completed by
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Date
Review date
Things you must know about me
Religion
Religious needs
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Ethnicity
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Doctor (GP)
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Address
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Telephone
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Other services and
professionals
involved with me
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Allergies
Risk of choking
when eating,
drinking or
swallowing
Completed by
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Date
Review date
Things you must know about me
My heart or breathing problems
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Medical interventions (how to take my
blood, blood pressure, give injections)
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My current medication
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Completed by
Date
Review date
Things you must know about me
Operations and illnesses I have had
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What to do if I am worried or upset
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Completed by
Date
Review date
Things that are important to me
How to communicate with me (such as
speaking, signing, pictures)
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How I take medication (such as tablets,
injections, syrup)
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How to tell if I am in pain
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Completed by
Date
Review date
Things that are important to me
Problems with my sight and hearing
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How I move around (such as walking
aids, posture in bed)
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My personal care (such as dressing,
washing)
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How I use the toilet (such as continence
aids, help to get to the toilet)
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Completed by
Date
Review date
Things that are important to me
How I eat (such as needing food cut up,
risk of choking, help with eating)
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How I drink (such as small amounts,
thickened fluids)
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How I sleep (such as sleep patterns,
routines)
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What support is best for me (keeping me
safe)
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Completed by
Date
Review date
My likes and dislikes
Things I like
Like what makes me happy, things I like to do such as
watching TV, reading, music and my routines
Things I don't like
Like shouting, some kinds of food and being touched.
Things I like
Things I don't like
Please do
these things
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Completed by
Don't do
these things
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Date
Review date
Notes
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This Hospital Passport is based on original work by
Gloucester Partnership NHS Trust, Wandsworth
Community Disability Team and Wandsworth Council.